Risk Factors for M.I.

Risk factors

By Mayo Clinic staff Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body, including arteries to your heart. You can improve or eliminate many of these risk factors to reduce your chances of having a first or subsequent heart attack.
Heart attack risk factors include:

• Age. Men who are 45 or older and women who are 55 or older are more likely to have a heart attack than are younger men and women.
• Tobacco. Smoking and long-term exposure to secondhand smoke damage the interior walls of arteries — including arteries to your heart — allowing deposits of cholesterol and other substances to collect and slow blood flow. Smoking also increases the risk of deadly blood clots forming and causing a heart attack.
• Diabetes. Diabetes is the inability of your body to adequately produce insulin or respond to insulin need properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes can occur in childhood, but it appears more often in middle age and among overweight people. Diabetes greatly increases your risk of a heart attack.
• High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. The risk of high blood pressure increases as you age, but the main culprits for most people are eating a diet too high in salt and being overweight. High blood pressure can also be an inherited problem.
• High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol in your blood increases your risk of a heart attack. Low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high LDL level is undesirable and is often a result of a diet high in saturated fats and cholesterol. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable. However, a high level of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol), which helps the body clean up excess cholesterol, is desirable and lowers your risk of heart attack.
• Family history of heart attack. If your siblings, parents or grandparents have had heart attacks, you may be at increased risk. Your family may have a genetic condition that raises unwanted blood cholesterol levels. High blood pressure also can run in families.
• Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure.
• Obesity. Obese people have a high proportion of body fat (a body mass index of 30 or higher). Obesity raises the risk of heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes.
• Stress. You may respond to stress in ways that can increase your risk of a heart attack. If you're under stress, you may overeat or smoke from nervous tension. Too much stress, as well as anger, can also raise your blood pressure.
• Illegal drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack.

S3 Cardiac Auscultation

http://www.youtube.com/watch?v=5Tz4eth26jc

Causes

S₃ is thought to be caused by the oscillation of blood back and forth between the walls of the ventricles initiated by the inflow of blood from the atria. The reason the third heart sound does not occur until the middle third of diastole is probably because during the early part of diastole, the ventricles are not filled sufficiently to create enough tension for reverberation. It may also be a result of tensing of the chordae tendineae during rapid filling and expansion of the ventricle.

Associations

It is associated with heart failure,^[5] caused by conditions which have:

Rapid ventricular filling

• Mitral regurgitation - this is when one of the mitral valve leaflets that usually stop blood flowing from the left ventricle to the left atria fails, allowing blood into the atria during systole. This means that the left atria will be overfilled, leading to rapid ventricular filling when the mitral valve opens.^[6]
• Elevated left atrial and left ventricular filling pressures, usually a result of a stiffened and dilated left ventricle
• Ventricular septal defect - this is a hole in the wall between the two ventricles, which allows rapid filling from the other ventricle.

Poor left ventricular function

• Post-MI - the death of tissue in the ventricular wall due to loss of blood supply causes wall areas which do not move as well as normal (hypokinesia), or not at all (akinesia), meaning they relax more slowly, so the ventricular filling is relatively too rapid.
• Dilated cardiomyopathy - the ventricular walls are abnormal for a variety of reasons, and become thin and stiff so do not relax well.

S3 can also be due to tricuspid regurgitation, and could indicate hypertensive heart disease.
In conditions affecting the pericardium or diseases that primarily affect the heart muscle (restrictive cardiomyopathies) a similar sound can be heard, but is usually more high-pitched and is called a 'pericardial knock'.
The S3 can also be confused with a widely split S2, or a mitral opening snap, but these sounds are typically of much higher pitch and occur closer to the onset of S2.

Normal Vital Signs

Vital signs

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Vital signs include the heart beat, breathing rate, temperature, and blood pressure. These signs may be watched, measured, and monitored to check an individual's level of physical functioning.
Normal vital signs change with age, sex, weight, exercise tolerance, and condition.
Normal vital sign ranges for the average healthy adult while resting are:

• Blood pressure: 90/60 mm/Hg to 120/80 mm/Hg
• Breathing: 12 - 18 breaths per minute
• Pulse: 60 - 100 beats per minute
• Temperature: 97.8 - 99.1 degrees Fahrenheit / average 98.6 degrees Fahrenheit

Causes of Iron Deficiency Anemia

What Causes Iron-Deficiency Anemia?

Not having enough iron in your body causes iron-deficiency anemia. Lack of iron usually is due to blood loss, poor diet, or an inability to absorb enough iron from food.

Blood Loss

When you lose blood, you lose iron. If you don't have enough iron stored in your body to make up for the lost iron, you'll develop iron-deficiency anemia.
In women, long or heavy menstrual periods or bleeding fibroids in the uterus may cause low iron levels. Blood loss that occurs during childbirth is another cause of low iron levels in women.
Internal bleeding (bleeding inside the body) also may lead to iron-deficiency anemia. This type of blood loss isn't always obvious, and it may occur slowly. Some causes of internal bleeding are:

• A bleeding ulcer, colon polyp, or colon cancer
• Regular use of aspirin or other pain medicines, such as nonsteroidal anti-inflammatory drugs (for example, ibuprofen and naproxen)
• Urinary tract bleeding

Blood loss from severe injuries, surgery, or frequent blood drawings also can cause iron-deficiency anemia.

Poor Diet

The best sources of iron are meat, poultry, fish, and iron-fortified foods (foods that have iron added). If you don't eat these foods regularly, or if you don't take an iron supplement, you're more likely to develop iron-deficiency anemia.
Vegetarian diets can provide enough iron if you eat the right foods. For example, good nonmeat sources of iron include iron-fortified breads and cereals, beans, tofu, dried fruits, and spinach and other dark green leafy vegetables.
During some stages of life, such as pregnancy and childhood, it may be hard to get enough iron in your diet. This is because your need for iron increases during these times of growth and development.

Inability To Absorb Enough Iron

Even if you have enough iron in your diet, your body may not be able to absorb it. This can happen if you have intestinal surgery (such as gastric bypass) or a disease of the intestine (such as Crohn's disease or celiac disease).
Prescription medicines that reduce acid in the stomach also can interfere with iron absorption.

CBC & TSH Testing

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A complete blood count (CBC) test measures the following:

• The number of red blood cells (RBC count)
• The number of white blood cells (WBC count)
• The total amount of hemoglobin in the blood
• The fraction of the blood composed of red blood cells (hematocrit)

The CBC test also provides information about the following measurements:

• Average red blood cell size (MCV)
• Hemoglobin amount per red blood cell (MCH)
• The amount of hemoglobin relative to the size of the cell (hemoglobin concentration) per red blood cell (MCHC)

The platelet count is also usually included in the CBC. 

How the Test is Performed

A blood sample is needed. For information on how this is done, see: Venipuncture

How to Prepare for the Test

There is no special preparation needed.

How the Test Will Feel

When the needle is inserted to draw blood, you may feel moderate pain, though most people feel only a prick or a stinging sensation. Afterward there may be some throbbing or bruising.

Why the Test is Performed

A complete blood count (CBC) is used to detect or monitor many different health conditions. It may be used to:

• Diagnose infections or allergies
• Detect blood clotting problems or blood disorders, including anemia
• Evaluate red blood cell production or destruction

Normal Results

Blood counts may vary with altitude. In general, normal results are:
RBC count:

• Male: 4.7 to 6.1 million cells/mcL
• Female: 4.2 to 5.4 million cells/mcL

WBC count:

• 4,500 to 10,000 cells/mcL

Hematocrit:

• Male: 40.7 to 50.3%
• Female: 36.1 to 44.3%

Hemoglobin:

• Male: 13.8 to 17.2 gm/dL
• Female: 12.1 to 15.1 gm/dL

Red blood cell indices:

• MCV: 80 to 95 femtoliter
• MCH: 27 to 31 pg/cell
• MCHC: 32 to 36 gm/dL

Note:

• cells/mcL = cells per microliter
• gm/dL = grams per deciliter;
• pg/cell = picograms per cell

The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

A high RBC or hematocrit may be due to:

• Dehydration (such as from severe diarrhea)
• Kidney disease with high erythropoietin production
• Low oxygen level in the blood for a long time due to heart or lung disease
• Polycythemia vera
• Smoking

A low RBC or hematacrit is a sign of anemia, which can result from:

• Autoimmune diseases such as lupus erythematosus or rheumatoid arthritis
• Blood loss (hemorrhage)
• Bone marrow failure (for example, from radiation, infection, or tumor)
• Chronic kidney disease
• Hemolysis (red blood cell destruction)
• Leukemia and other blood cancers
• Long-term infections such as hepatitis
• Poor diet and nutrition, causing too little iron, folate, vitamin B12, or vitamin B6
• Multiple myeloma

A lower than normal white blood cell count is called leukopenia. A decreased WBC count may be due to:

• Autoimmune diseases (such as systemic lupus erythematosus)
• Bone marrow failure (for example, due to infection, tumor, radiation, or fibrosis)
• Disease of the liver or spleen

High numbers of WBCs is called leukocytosis. It can result from:

• Infectious diseases
• Inflammatory disease (such as rheumatoid arthritis or allergy)
• Leukemia
• Severe emotional or physical stress
• Tissue damage (such as burns)

Low hemoglobin values may be due to:

• Anemia (various types)
• Blood loss

Risks

There is very little risk involved with having your blood taken. Veins and arteries vary in size from one patient to another and from one side of the body to the other. Taking blood from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Considerations

RBCs transport hemoglobin which, in turn, carries oxygen. The amount of oxygen received by body tissues depends on the amount and function of RBCs and hemoglobin.
WBCs are mediators of inflammation and the immune response. There are various types of WBCs that normally appear in the blood:

• Neutrophils (polymorphonuclear leukocytes)
• Band cells (slightly immature neutrophils)
• T-type lymphocytes (T cells)
• B-type lymphocytes (B cells)
• Monocytes
• Eosinophils
• Basophils

TSH test

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A TSH test is a lab test that measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It tells the thyroid gland to make and release thyroid hormones into the blood.

How the Test is Performed

A blood sample is needed. For information on how this is done, see: Venipuncture
Other tests that may be done at the same time include:

• T3 test
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  Triiodothyronine (T3) is a thyroid hormone. It plays an important role in the body's control of metabolism.
  A laboratory test can be done to measure the amount of T3 in your blood
  

  Normal Results

  The range for normal values is 100 - 200 ng/dL (nanograms per deciliter).
  The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different specimens.Talk to your doctor about the meaning of your specific test results.
  

  What Abnormal Results Mean

  High levels of T3 in the blood may occur in pregnancy, with the use of birth control pills or estrogen, from liver disease, or as part of an inerited condition.
  Higher-than-normal levels of T3 may be a sign of:
  

  • Overactive thyroid gland (for example, Graves disease)
  • T3 thyrotoxicosis (rare)
  • Toxic nodular goiter 

  Lower-than-normal levels may be due to:
  

  • Short- or long-term illness
  • Thyroiditis (swelling or inflammation of the thyroid gland -- Hashimoto's disease is the most common type)
  • Starvation
  • Underactive thyroid gland
   
• T4 test
• T4 (thyroxine) is a hormone produced by the thyroid gland. A laboratory test can be done to measure the amount of T4 in your blood.

• Normal Results

  A typical normal range is 4.5 to 11.2 micrograms per deciliter (mcg/dL).
  Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
  The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.
  

  What Abnormal Results Mean

  Greater than normal levels of T4 may be due to conditions that involve an overactive thyroid, including:
• Graves disease
• Germ cell tumors
• High levels of the protein that carries T4 in the blood (can occur with pregnancy, use of birth control pills or estrogen, liver disease, and as part of an inherited condition)
• Iodine-induced hyperthyroidism
• Subacute thyroiditis
• Toxic multinodular goiter
• Trophoblastic disease
• Over-treatment with thyroid hormone medicine

Lower than normal levels of T4 may be due to:

• Hypothyroidism (including Hashimoto's disease and several other disorders involving an underactive thyroid)
• Illness
• Malnutrition or fasting
• Use of certain medications

•  

How to Prepare for the Test

There is no preparation needed for this test. Ask your health care provider about any medicines you are taking that may affect the test results. Do not stop taking any medicines without first asking your health care provider.
Medicines you may need to stop taking include:

• Amiodarone
• Dopamine
• Lithium
• Potassium iodide
• Prednisone

How the Test Will Feel

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the Test is Performed

Your doctor will order this test if you have symptoms or signs of an overactive or underactive thyroid gland. It is also used to monitor treatment of these conditions.

Normal Results

Normal values can range from 0.4 - 4.0 mIU/L (milli-international units per liter), depending on:

• Your symptoms
• Results of other thyroid lab tests
• Whether you are already being treated for thyroid problems

Even without signs or symptoms of an underactive thyroid (hypothyroidism), you will need to be followed closely by your doctor if your TSH level is over 3.5 mIU/L but your T4 test is normal (called subclinical hypothyroidism).
If you are being treated for a thyroid disorder, your TSH level should be between 0.5 and 2.0 mIU/L.
The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples.Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Higher-than-normal TSH levels are most often due to an underactive thyroid gland (hypothyroidism). There are many causes of this problem.
Lower-than-normal levels may be due to an overactive thyroid gland, which can be caused by:

• Graves disease
• Toxic nodular goiter
• Use of certain medications (including glucocorticoids/steroids, and opioid painkillers such as morphine)

Risks

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Alternative Names

Thyrotropin; Thyroid stimulating hormone

Causes of Menorrhagia

A change in hormone levels is a common cause of abnormal menstrual bleeding.

Other causes of heavy, prolonged, or irregular menstrual bleeding include:

• Bleeding disorders such as Von Willebrand disease
• Cancer of the lining of the uterus
• Changes in birth control pills or hormone medications
• Changes in exercise routine
• Diet changes
• Endometrial hyperplasia (thickening/build-up of the lining of the uterus)
• Infection in the uterus (pelvic inflammatory disease)
• Medical conditions such as thyroid and pituitary disorders, diabetes, cirrhosis of the liver, and systemic lupus erythematosus
• Noncancerous growths in the womb, including uterine fibroids, uterine polyps, and adenomyosis
• Polycystic ovary syndrome
• Pregnancy complicationss such as miscarriage or ectopic pregnancy
• Recent injury or surgery to the uterus
• Recent weight loss or gain
• Stress
• Use of an intrauterine device (IUD) for birth control
• Use of certain drugs such as steroids or blood thinners (for example, warfarin or Coumadin)

Absence of Alpha-Sarcoglycans Related to Limb-Girdle Muscular Dystrophy

Dystrophin-glycoprotein complex bridges the inner cytoskeleton (F-actin) and the basal lamina. Mutations in all sarcoglycans, dysferlin, and caveolin-3, as well as mutations that cause abnormal glycosylation of alpha-dystroglycan can result in limb-girdle muscular dystrophy syndrome. Reprinted with permission from Cohn RD. Dystroglycan: important player in skeletal muscle and beyond. In: Neuromuscular Disorders. Vol. 15. Cohn RD. Elsevier; 2005: 207-17. 7, 20 

 

The sarcoglycans are a family of transmembrane proteins (α, β, γ, δ or ε) involved in the protein complex responsible for connecting the muscle fibre cytoskeleton to the extracellular matrix, preventing damage to the muscle fibre sarcolemma through shearing forces.
The dystrophin glycoprotein complex (DGC) is a membrane-spanning complex that links the interior cytoskeleton to the extracellular matrix in muscle. The sarcoglycan complex is a subcomplex within the DGC and is composed of several muscle-specific, transmembrane proteins (alpha-, beta-, gamma-, delta- and zeta-sarcoglycan). The sarcoglycans are asparagine-linked glycosylated proteins with single transmembrane domains.
The disorders caused by the mutations of the sarcoglycans are called sarcoglycanopathies. Mutations in the α, β, γ or δ genes (not ε) encoding these proteins can lead to the associated limb-girdle muscular dystrophy.

(Wikipedia)

What is Gower's Sign?

http://medicalcenter.osu.edu/patientcare/healthcare_services/muscular_dystrophy/Pages/index.aspx

A tell-tale clinical characteristic for Duchenne muscular dystrophy (DMD) is Gowers' sign. Children with Duchenne muscular dystrophy find it very hard to get up from a sitting or lying position on the floor. They first pull up to their hands and knees. The child walks his/her hands up their legs to brace themselves as they rise to a standing position.

Typical Gower's Sign

Second session

This is the second post. Once we have all read the chapter we can decide who is writing up which question and research. Also, please email me anything that you would like to post from the research done about our last case. I will update it as the emails roll through.

Ester

In a 38 year old pregnant woman, is CVS or amniocentesis a more reliable method in diagnosing a chromosomal abnormality in the unborn fetus? 

First SGL Session!

Hey guys,

So this will be our blog where we can post whatever we think is relevant to our topic. Please feel free to share any images/websites you think are useful for SGL. I think you may have to have a gmail account to post comments but I am not 100% sure. Either way, its a communication tool that will be useful for our sessions.

Thanks!
Ester